Medicine and Health Sciences Commons^™

Annual Report To The Nation On The Status Of Cancer, 1975-2006, Featuring Colorectal Cancer Trends And Impact Of Interventions (Risk Factors, Screening, And Treatment) To Reduce Future Rates, Brenda K. Edwards, Elizabeth Ward, Betsy A. Kohler, Christie Eheman, Ann G. Zauber, Robert N. Anderson, Ahmedin Jemal, Maria J. Schymura, Iris Lansdorp-Vogelaar, Laura C. Seeff, Marjolein Van Ballegooijen, S. Luuk Goede, Lynn A. G. Ries

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BACKGROUND. The American Cancer Society, the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information regarding cancer occurrence and trends in the United States. This year’s report includes trends in colorectal cancer (CRC) incidence and death rates and highlights the use of microsimulation modeling as a tool for interpreting past trends and projecting future trends to assist in cancer control planning and policy decisions.

METHODS. Information regarding invasive cancers was obtained from the NCI, CDC, and NAACCR; and information …

Female Veterans Of The Oef/Oif Conflict: Concordance Of Ptsd Symptoms And Substance Misuse, Sarah E. Nunnink, Gali Goldwaser, Pia S. Heppner, James O.E. Pittman, Caroline M. Nievergelt, Dewleen G. Baker

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This study examined the post-deployment rates of comorbid PTSD and substance abuse in a cohort of female veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). Female OEF/ OIF veterans and reservists (N=36) completed a battery of assessments as part of a larger study. Of the 36 participants, 11 (31%) screened positive for posttraumatic stress disorder (PTSD), 17 (47%) screened positive for high-risk drinking and 2 (6%) screened positive for drug abuse. Higher scores on measures of alcohol and drug use predicted positive PTSD status (p≤0.01) and alcohol misuse was significant in explaining …

Family Level Phylogenies Reveal Modes Of Macroevolution In Rna Viruses, Andrew Kitchen, Laura Shackelton, Edward Holmes

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Despite advances in understanding the patterns and processes of microevolution in RNA viruses, little is known about the determinants of viral diversification at the macroevolutionary scale. In particular, the processes by which viral lineages assigned as different “species” are generated remain largely uncharacterized. To address this issue, we use a robust phylogenetic approach to analyze patterns of lineage diversification in five representative families of RNA viruses. We ask whether the process of lineage diversification primarily occurs when viruses infect new host species, either through cross-species transmission or codivergence, and which are defined here as analogous to allopatric speciation in animals, …

Surgical Intervention For Infective Endocarditis In A Veteran Population, Lorraine D. Cornwell, Danny Chu, Scott A. Lemaire, Joseph Huh, Shubhada Sansgiry, Joseph S. Coselli, Faisal G. Bakaeen

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Abstract

BACKGROUND: Surgical management of infective endocarditis can be challenging. Veteran patients are unique because they often have significant comorbidities, and surgical management of endocarditis in this population has not been well described.

METHODS: Using a prospective database, 46 consecutive patients who underwent valve surgery for acute infective endocarditis between 1987 and 2009 were identified. Survival was assessed using the Kaplan-Meier method.

RESULTS: All patients were men (mean age, 56±9 years). The most common indication for surgical intervention was congestive heart failure (60%). The aortic valve was the only valve infected in most patients (65%). Operative morbidity …

Mortality Patterns Of Army Chemical Corps Veterans Who Were Occupationally Exposed To Herbicides In Vietnam, Yasmin Cypel, Han Kang

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PURPOSE: This research examined the risk of disease-related mortality of the Army Chemical Corps (ACC) veterans who handled/sprayed herbicides in Vietnam in comparison with their non-Vietnam veteran peers or U.S. men.

METHODS: Vital status was determined through December 31, 2005. All-cause mortality and cause-specific mortality were compared for individuals who served in Vietnam (n Z 2872) versus those who did not (n Z 2737). Similar analyses were completed on a subset of the original Vietnam cohort that consisted of individuals who either reported spraying herbicide (n Z 662) or not (n Z 811). The observed deaths for each …

Public Health Clinical Demonstration Project For Smoking Cessation In Veterans With Posttraumatic Stress Disorder, Eric A. Dedert, Sarah M. Wilson, Patrick S. Calhoun, Scott D. Moore, Kim W. Hamlett-Berry, Jean C. Beckham

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Veterans with post traumatic stress disorder are at high risk for smoking and experience difficulty with smoking cessation. We designed this clinical demonstration project to provide a low-cost, feasibly implemented smoking cessation intervention that would maximize the number of smokers who accessed the intervention. Five hundred eighty-four veteran smokers were contacted by invitational letters. Interested veterans received follow-up telephone calls using standardized scripts offering three intervention resources: 1) a referral to the National Cancer Institute's Smoking Quitline, 2) web-based counseling, and 3) local Veteran Affairs pharmacologic treatment for smoking cessation. Twenty-three percent of survey recipients participated in the clinical program. …

Patterns Of Drug Use And Abuse Among Aging Adults With And Without Hiv: A Latent Class Analysis Of A Us Veteran Cohort, Traci C. Green, Trace Kershaw, Haiqun Lin, Robert Heimer, Joseph L. Goulet, Kevin L. Kraemer, Adam J. Gordon, Steve A. Maisto, Nancy L. Day, Kendall Bryant, David A. Fiellin, Amy C. Justice

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This study characterized the extent and patterns of self-reported drug use among aging adults with and without HIV, assessed differences in patterns by HIV status, and examined pattern correlates. Data derived from 6351 HIV-infected and uninfected adults enrolled in an eight-site matched cohort, the Veterans Aging Cohort Study (VACS). Using clinical variables from electronic medical records and sociodemographics, drug use consequences, and frequency of drug use from baseline surveys, we performed latent class analyses (LCA) stratified by HIV status and adjusted for clinical and socio-demographic covariates. Participants were, on average, age 50 (range 22–86), primarily male (95%) and African-American (64%). …

An Examination Of The Construct Validity Of Posttraumatic Stress Disorder With Veterans Using A Revised Criterion Set, Anouk L. Grubaugh, Mary E. Long, Jon D. Elhai, B. Christopher Frueh, Kathryn M. Magruder

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Ongoing concerns exist in the literature regarding the construct of posttraumatic stress disorder (PTSD) and how to best conceptualize and measure this disorder. We compared the traditional DSM-IV PTSD symptom criteria (i.e., symptoms from clusters B, C, and D) to a revised criterion set that omits overlapping mood and other anxiety symptoms on PTSD prevalence, PTSD diagnostic caseness, associated psychiatric comorbidity, functional status, and structural validity using a cross-sectional, multi-site primary care sample of 747 veterans. After removing items theorized to overlap with mood and other anxiety disorders, PTSD prevalence was identical using both criterion sets (i.e., 12%). Overall, there …

Positive Correlation Of Employment And Psychological Well-Being For Veterans With Major Abdominal Surgery, David J. Horner, Christopher S. Wendel, Raymond Skeps, Susan M. Rawl, Marcia Grant, C. Max Schmidt, Clifford Y. Ko, Robert S. Krouse

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BACKGROUND: Intestinal stomas (ostomies) have been associated negatively with multiple aspects of health-related quality of life. This article examines the relationship between employment status and psychological well-being (PWB) in veterans who underwent major bowel procedures with or without ostomy.

METHODS: Veterans from 3 Veterans Affairs (VA) medical centers were surveyed using the City of Hope ostomy-specific questionnaire and the Short Form 36 item Veteran’s version (SF-36V). Response rate was 48% (511 of 1,063). Employment and PWB relationship was assessed using multiple regression with age, income, SF-36V physical component summary (PCS), and employment status as independent variables.

RESULTS: Employed veterans reported …

The Past, Present, And Future Of Comparative Effectiveness Research In The Us Department Of Veterans Affairs, Joel Kupersmith, Alexander K. Ommaya

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A particular challenge for the healthcare provider and the patient is to choose among competing therapeutic approaches for a particular condition. Often, the relative benefits and risks of potential therapies are not uniformly available from the existing scientific information. Many have pointed to the need for more comparative effectiveness research (CER) to aide in these decisions. The US Department of Veterans Affairs (VA) has a long history of conducting CER. The success of the VA CER program has been facilitated by several important aspects of scientific infrastructure related to (1) research question refinement, (2) study design, planning and coordination, (3) …

Comparisons Of Quality Of Surgical Care Between The Us Department Of Veterans Affairs And The Private Sector, Sierra R. Matula, Amal N. Trivedi, Isomi Miake-Lye, Peter A. Glassman, Paul Shekelle, Steven Asch

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The Department of Veterans Affairs (VA) is the largest integrated health system in the United States. Since its establishment in 1930, the VA has provided medical and surgical care to veterans of US military service. VA services are provided primarily by salaried federal employees working in government-operated facilities.

By the 1990s, the VA had developed a negative reputation, with widespread concerns about poor quality of care and systematic inefficiencies.1-3 An overhaul of the organization took place in the mid-1990s to improve both clinical care and the greater VA health system.With regard to quality of surgical care in the VA, changes …

Demographic And Clinical Variation In Veterans Health Administration Provision Of Assistive Technology Devices To Veterans Poststroke, Sandra L. Hubbard Winkler, Diane C. Cowper Ripley, Samuel Wu, Dean M. Reker, Bruce Vogel, Shirley G. Fitzgerald, William C. Mann, Helen Hoenig

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Objectives: To examine variation in provision of assistive technology (AT) devices and the extent to which such variation may be explained by patient characteristics or Veterans Health Administration (VHA) administrative region.

Design: Retrospective population-based study.

Setting: VHA.

Participants: Veterans poststroke in fiscal years 2001 and 2002 (N=12,046).

Interventions: Not applicable.

Main Outcome Measure: Provision of 8 categories of AT devices.

Results: There was considerable regional variation in provision of AT. For example, differences across administrative regions in the VHA ranged from 5.1 to 28.1 standard manual wheelchairs per 100 veterans poststroke. Using logistic …

Investigating The Risk Of Cancer In 1990–1991 Us Gulf War Veterans With The Use Of State Cancer Registry Data, Heather A. Young, Jessica D. Maillard, Paul H. Levine, Samuel J. Simmens, Clare M. Mahan, Han K. Kang

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PURPOSE: The purpose of this study was to determine whether proportional cancer incidence is greater among Gulf War veterans compared with non-Gulf War veterans.

METHODS: Files obtained from the Defense Manpower Data Center included data for 621,902 veterans who were deployed to the Persian Gulf during the 1990 to 1991 Gulf War (August 2, 1990, to March 1, 1991) and 746,248 non-Gulf War veteran controls. Identification of veterans who received a cancer diagnosis between 1991 and 2006 was accomplished through record linkage of the Defense Manpower Data Center dataset with files from 28 state cancer registries and the Department of …

Detection Of West Nile Virus In Stable Flies (Diptera: Muscidae) Parasitizing Juvenile American White Pelicans, Gregory Johnson, Nicholas Panella, Kristina Hale, Nicholas Komar

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Stable flies, Stomoxys calcitrans (L.) (Diptera: Muscidae), an economically important pest of livestock and humans, were observed parasitizing prefledged American white pelicans, Pelecanus erythrorhynchos (Pelecaniformes: Pelecanidae), in a pelican breeding colony in northeastern Montana where die-offs attributed to West Nile virus (family Flaviviridae, genus Flavivirus, WNV) have occurred since 2002. Engorged and unengorged flies were collected off nine moribund chicks. Of 29 blood-engorged flies testing positive for vertebrate DNA, all 29 contained pelican DNA. Virus isolation was performed on 60 pools (1,176 flies) of unengorged flies using Vero cell plaque assay. Eighteen pools were positive for WNV …

Uses Of Youth Risk Behavior Survey And School Health Profiles Data: Applications For Improving Adolescent And School Health, Kathryn Foti, Alexandra Balaji, Shari Shanklin

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BACKGROUND: To monitor priority health risk behaviors and school health policies and practices, respectively, the Centers for Disease Control and Prevention (CDC) developed the Youth Risk Behavior Surveillance System (YRBSS) and the School Health Profiles (Profiles). CDC is often asked about the use and application of these survey data to improve adolescent and school health. The purpose of this article is to describe the importance and potential impact of Youth Risk Behavior Survey (YRBS) and Profiles data based on examples from participating sites.

METHODS: The authors spoke with representatives from 25 state and 8 local agencies funded by …

Understanding Attitudes Toward People With Down Syndrome, Jill E. Pace, Mikyong Shin, Sonja A. Rasmussen

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Understanding attitudes of the public toward people with Down syndrome is important because negative attitudes might create barriers to social integration, which can affect their success and quality of life. We used data from two 2008 U.S. surveys (HealthStyles© survey of adults 18 years or older and YouthStyles© survey of youth ages 9–18) that asked about attitudes toward people with Down syndrome, including attitudes toward educational and occupational inclusion and toward willingness to interact with people with Down syndrome. Results showed that many adults continue to hold negative attitudes toward people with Down syndrome: A quarter of respondents agreed that …